Chapter 3.8 Serious bacterial infection

Newborns with documented risk factors are more likely to develop serious bacterial infection. All of the danger signs listed in section 3.6 are signs of serious bacterial infection, but there are others:

  • Severe jaundice
  • Severe abdominal distension

Localizing signs of infection are:

  • Signs of pneumonia
  • Many or severe skin pustules
  • Umbilical redness extending to the peri-umbilical skin
  • Umbilicus draining pus
  • Bulging fontanelle
  • Painful joints, joint swelling, reduced movement and irritability if these parts are handled

Treatment

Antibiotic therapy

Empirical antibiotics should be given to children with suspected neonatal sepsis.

  • Admit to hospital.
  • When possible, do a lumbar puncture and obtain blood cultures before starting antibiotics.
  • For newborns with any signs of serious bacterial infection or sepsis, give ampicillin (or penicillin) and gentamicin as first-line antibiotic treatment
  • If at greater risk of staphylococcus infection (extensive skin pustules, abscess or omphalitis in addition to signs of sepsis), give IV cloxacillin and gentamicin.
  • The most serious bacterial infections in newborns should be treated with antibiotics for at least 7–10 days.
  • If an infant is not improving within 2–3 days, change the antibiotic treatment or refer the infant for further management.

Other treatment

  • If the infant is drowsy or unconscious, ensure that hypoglycaemia is not present; if it is, give 2 ml/kg 10% glucose IV.
  • Treat convulsions with phenobarbital.
  • For management of pus draining from eyes.
  • If the child is from a malarious area and has fever, take a blood film to check for malaria. Neonatal malaria is very rare. If confirmed, treat with artesunate or quinine.